The new functions of the gut in the control of glucose homeostasis.

PURPOSE OF REVIEW: It has become clear during the past few years that the intestine is more than a digestive tract. In addition to its role as a subtle endocrine organ, its participation in endogenous glucose production, a property so far believed to be restricted to the liver and kidney, has been emphasized.

RECENT FINDINGS: The role of the gut in the regulation of glucose homeostasis has received further experimental accreditation from both animal and human studies. In relation to the molecular mechanisms of control of glucose production the potential regulatory role of glutaminase and glycerokinase has been suggested from studies of fasting, and the transcription of the glucose-6 phosphatase gene has been specified in an intestinal context. Furthermore, two newly described metabolic pathways accounting for the transepithelial transport of glucose have received further support: from the intestinal lumen to inside the enterocyte, involving a translocation of the glucose transporter Glut2 to the apical membrane, and from inside the enterocyte into the blood, involving glucose 6-phosphatase and independent of Glut2.

SUMMARY: The new knowledge regarding the control of glucose, glutamine, and glycerol metabolisms in the small intestine should be of interest to those who care for diabetic or septic patients, or are involved in nutrition research in humans. They should also be of importance in the knowledge of inherited genetic deficiencies, such as glycogen storage disease type 1 (Von Gierke disease) and the Fanconi-Bickel and glucose-galactose malabsorption syndromes.